The authors introduced the study by noting that heterosexual anal sex, which poses risks for STDs, "is not uncommon in the United States." "However, who engages in it and why are not well understood, particularly among young adults."

In Hartford, Conn., and Philadelphia from 2006 to 2008, data on topics related to sexual health were collected via survey (483 respondents) and qualitative interviews (70 individuals) from black and Puerto Rican persons ages 18 to 25. Predictors of anal sex with the most recent serious heterosexual partner were assessed by bivariate and multivariate analyses. The team analyzed interview transcripts to assess experiences with anal sex and reasons for engaging or abstaining.

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Anal sex was reported by 34 percent of survey respondents. It was more common with serious (22 percent) as opposed to casual (8 percent) partners. Black participants were less likely than Puerto Rican respondents to report anal sex (odds ratio, 0.3); women were more likely than men to report anal sex (2.9).

The qualitative cohort found perceptions of anal sex as painful and unappealing were the predominant reasons for abstaining. Sexual pleasure and, in serious relationships, intimacy were the main reasons cited for engaging in it. During anal sex, condom use "was rare and was motivated by STD or hygiene concerns."

"Heterosexual anal sex is not an infrequent behavior and should be considered in a broad sexual health context, not simply as an indicator of STD risk," the authors concluded. "Health providers should address it openly and, when appropriate, as a positive sexual and emotional experience."

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